Sauro Khara M, Wiebe Samuel, Macrodimitris Sophie, Jetté Nathalie
Department of Clinical Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Epilepsia. 2016 Nov;57(11):1771-1778. doi: 10.1111/epi.13563. Epub 2016 Oct 10.
Quality and safety in epilepsy monitoring units (EMUs) are of great importance because patients' seizures are induced rather than prevented in this hospital setting. However, the measurement and evaluation of quality and safety in EMUs are heterogeneous, as are practices and processes of care. To improve the measurement of quality and safety in EMUs, we sought to develop evidence-based and consensus-driven quality indicators, adhering to previously described methodologic standards.
Candidate quality indicators were identified using a recent systematic review on quality and safety indicators in EMUs. These were supplemented by expert opinion to identify other indicators that had not been reported previously. The candidate quality indicators were then evaluated using a modified Delphi technique among a multidisciplinary EMU quality improvement team. Candidate indicators identified as important and feasible through the Delphi technique were then developed into quality metrics.
Thirty-four candidate indicators were abstracted from 135 studies included in the earlier systematic review, and two additional candidate indicators were suggested through consensus from experts. Consensus was reached after two modified Delphi rounds for 25 quality indicators identified as important. These 25 indicators were then developed into quality metrics using a standardized data collection form and were deployed in an online database for systematic data capture and further analyses.
These quality indicators have the potential to improve the reporting of quality and safety in EMUs through standardized measurement and evaluation of the quality and safety of care. The ultimate goal is improved patient care and clinical outcomes through safer and better care for people with epilepsy in the EMU.
癫痫监测单元（EMU）的质量与安全至关重要，因为在这种医院环境中，患者的癫痫发作是诱发而非预防的。然而，EMU质量与安全的测量和评估存在异质性，护理实践和流程也是如此。为改进EMU质量与安全的测量，我们力求遵循先前描述的方法学标准，制定基于证据且由共识驱动的质量指标。
通过对EMU质量与安全指标的近期系统评价确定候选质量指标。通过专家意见补充这些指标，以识别先前未报告的其他指标。然后在多学科EMU质量改进团队中使用改良的德尔菲技术对候选质量指标进行评估。通过德尔菲技术确定为重要且可行的候选指标随后被制定为质量指标。
从早期系统评价纳入的135项研究中提取了34个候选指标，专家共识又提出了另外两个候选指标。经过两轮改良德尔菲法，对确定为重要的25个质量指标达成了共识。然后使用标准化数据收集表将这25个指标制定为质量指标，并部署到在线数据库中进行系统的数据采集和进一步分析。
这些质量指标有可能通过对护理质量与安全进行标准化测量和评估，改善EMU质量与安全的报告。最终目标是通过在EMU为癫痫患者提供更安全、更好的护理，改善患者护理和临床结局。
